Chapter 4. Social and
cultural factors in nutrition

Social factors and cultural practices in most countries have a
very great influence on what people eat, on how they prepare food, on their
feeding practices and on the foods they prefer. Nonetheless, cultural food
practices are very rarely the main, or even an important, cause of malnutrition.
On the contrary, many practices are specifically designed to protect and promote
health; providing women with rich, energy-dense foods during the first months
following childbirth is an example. It is true, however, that some traditional
food practices and taboos in some societies may contribute to nutritional
deficiencies among particular groups of the population. Nutritionists need to
have a knowledge of the food habits and practices of the communities in which
they work so that they can help to reinforce the positive habits as well as
strive to change any negative ones.

Food habits and their
origins

All people have their likes and dislikes and their beliefs
about food, and many people are conservative in their food habits. They tend to
like what their mothers cooked for them when they were young, the foods that are
served on festive occasions or those eaten with friends and family away from
home during their childhood. The foods that adults ate without a second thought
in childhood are seldom totally disagreeable to them in later life.

What one society regards as normal or even highly desirable,
however, another society may consider revolting or totally inedible. Animal milk
is commonly consumed and liked by many people in Asia, Africa, Europe and the
Americas, but in China it is rarely taken. Lobsters, crabs and shrimps are
considered delicacies and prized foods by many people in Europe and North
America, but are revolting to many people in Africa and Asia, especially those
who live far from the sea. The French eat horse meat; the English generally do
not. Many people will delightedly consume the flesh of monkeys, snakes, dogs and
rats or will eat certain insects, yet many others find these foods most
unappealing. Religion may have an important role in forbidding the consumption
of certain foods. For example, neither the Muslim nor the Jewish peoples consume
pork, and Hindus do not eat beef and are frequently vegetarians.

Food habits differ most widely in regard to which foods of
animal origin are liked, disliked, eaten or not eaten in a society. The foods in
question comprise many of those that are rich in good-quality protein and that
contain haem iron, both of which are important nutrients. People who do not
consume these foods are deprived of the opportunity of obtaining these nutrients
easily. On the other hand, those who overconsume animal flesh, some seafoods,
eggs and other foods of animal origin will have undesirable amounts of saturated
fat and cholesterol in the diet. Balanced consumption is the key.

Relatively few people or societies have strong negative
feelings about consuming cereals, roots, legumes, vegetables or fruit. They may
have strong preferences and likes, but most maize-eating people are also willing
to eat rice, and most rice-eating people will eat wheat products.

It is often stated that food habits seldom or never change and
are difficult to change. This is not true; in many countries the current staple
foods are not the same as those eaten even a century ago. Food habits and
customs do change, and they are influenced in many different ways. Maize and
cassava are not indigenous to Africa, yet they are now major food staples in
many African countries. Potatoes originated in the Americas and later became an
important food in Ireland.

Food preferences are not made and abolished by whims and
fancies, of course. More often the adjustments are generated by social and
economic changes that take place throughout the community or society. The issue
is often not what foods are eaten but rather how much of each food is eaten and
how the consumption is distributed within the society or within the
family.

The tendency of many wage-earners to spend almost all their
wages within a few days of receiving them often results in a family diet of
varying nutritive value. The family eats much better just after one payday than
just before the next. Wages are often paid monthly, and there seems little doubt
that a change to weekly payment of wages would improve the diet of wage-earners
and their families.

The person who controls the family finances influences
(intentionally or unintentionally) both the family diet and the food fed to
children. In general, when mothers, rather than just fathers, have some control
over finances, the family diet is likely to be better. When the mother has
little control over family funds, dietary arrangements may become haphazard or
even dangerous.

Nutrition education has been an important influence on food
habits, and not always a positive one. Fortunately, the days are long gone when
nutritionists promoted costly protein-rich foods to eople who couldn't possibly
afford them. Unfortunately, the tendency to single out foods or nutrients either
to promote or to prohibit has not yet gone, nor has the tendency to try to teach
by creating fear and taking the enjoyment out of eating. However, change always
comes slowly and old habits die hard; people who were taught in these old ways
are still responsible for feeding themselves and their families, and they may
find it hard to change again.

Nutritional advantages of traditional
food habits

The traditional diets of most societies in developing countries
are good. Usually only minor changes are needed to enable them to satisfy the
nutrient requirements of all members of the family. Although the quantity of
food eaten is a more common problem than the quality, this chapter focuses on
types of food and eating habits.

Eating certain protein-rich foods such as insects, snakes,
baboons, mongooses, dogs, cats, unusual seafoods and snails is definitely
beneficial. Another habit that is good nutritionally is the consumption of
animal blood. Some African tribes puncture the vein of a cow, draw off a
calabash of blood, arrest the bleeding and consume the blood, usually after
mixing it with milk. Blood is a rich food, and mixed with milk it is highly
nutritious.

A custom frequently found among pastoral and other peoples is
the drinking of soured or curdled milk, rather than fresh. The souring of milk
has little effect on its nutritive value but often substantially reduces the
number of pathogenic organisms present. In communities where milking is not
hygienically performed and where the containers into which the milk goes are
likely to be contaminated, it is safer to drink sour rather than fresh milk.
Boiled milk would be safer still.

Many societies, for example in Indonesia and in parts of
Africa, partly ferment foods before consumption. Fermentation may both improve
the nutritional quality and reduce bacterial contamination of the
food.

The traditional use of certain dark green leaves among rural
peoples is another beneficial practice and should be encouraged. These leaves
are rich sources of carotene, ascorbic acid, iron and calcium; they also contain
useful quantities of protein. Non-cultivated or wild dark green leaves such as
amaranth leaves as well as those from cultivated food crops such as pumpkin,
sweet potato and cassava are much richer in vitamins than pale, leafy vegetables
of European origin such as cabbage and lettuce. Well-meaning expatriate
horticulturists in Africa have too often tried to get villagers to cultivate
such European vegetables rather shall their traditional vegetables.

Many wild fruits are rich in vitamin C; an example is the pulp
within the pod of the frequently consumed baobab.

Some communities sprout legume seeds prior to cooking, which
enhances their nutritive value, as does the soaking of whole-grain cereals before
their processing into local beers and some non-alcoholic beverages. These seeds
and grains usually have a high vitamin B content. Finally, it cannot be stressed
too strongly that the traditional method of infant feeding- from the breast
- is nutritionally far superior to bottle-feeding (see Chapter
7).

Food taboos

A number of food habits and practices are poor from a
nutritional point of view. Some practices result from traditional views about
food that are liable to change under the influence of neighbouring peoples,
travel, education, etc. Other food practices are governed by definite
taboos.

A taboo may be followed by a whole national group or tribe, by
part of a tribe or by certain groups in the society. Within the society,
different food customs may be practiced only by women or children, or by
pregnant women or female children. In certain cases traditional food customs are
practiced by a particular age group, and in other instances a taboo may be
linked with an occupation such as hunting. At other times or in other
individuals a taboo may be imposed because of some particular event such as an
illness or an initiation ceremony.

Although these matters border on the realm of anthropology, it
is important for a nutritionist to be familiar with the food customs of people
in order to be able to improve their nutritional status through nutrition
education or other means. Moreover, it is evident that anthropology and
sociology are important to the nutrition worker who is either investigating or
trying to improve the nutritional status of any community.

Some customs and taboos have known origins, and many are
logical, although the original reasons may no longer be known. The custom may
have become part of the religion of the people involved. For example, the Jewish
taboo against pork was probably introduced to eliminate the prevalent pork
tapeworm, which was thought to be sapping the strength of the Jewish people.
Even though 2 000 years later it is now possible to eat pork safely, Jews still
do not eat pork. Muslims share this view about pork. In neither case is this a
nutritionally damaging taboo.

Many taboos concern the consumption of protein-rich animal
foods, often by those groups of the community most in need of protein. A common
taboo in Africa against the consumption of eggs is rapidly disappearing. This
taboo usually applies to females, who are said to become sterile if they eat
eggs. The psychological connection between human fertility and the egg is
obvious. In other places the custom applies to children, perhaps to discourage
them from stealing the eggs of setting hens, which would endanger the survival
of poultry. Other customs, again often affecting women and children, concern
fish. These customs may amount to a full taboo, although people not used to fish
often dislike it merely because they find its smell distasteful or its
appearance "snake-like". Many cultures have strong views about the consumption
of milk or milk products.

The customs that prohibit consumption of certain nutritionally
valuable foods may not have an important overall nutritional impact,
particularly if only one or two food items are affected. Some societies,
however, forbid such a wide range of foods to women during pregnancy that it is
difficult for them to obtain a balanced diet.

Many of the nutritionally undesirable taboos that existed a
quarter of a century ago have weakened or disappeared as a result of education,
mixing of people from different societies and travel. Of those that remain, some
food habits may seem illogical and their origins obscure, but it is not
advisable for outsiders to try to alter ancient food habits without looking very
closely into their origins. Moreover, it makes no sense to attempt to alter a
habit that does not negatively affect nutritional status.

Nutritionally bad habits, like all other habits, are best
changed by the people who have them. In this regard, influential local people,
with the welfare of their fellows at heart, may join nutritionists and become
part of an important alliance pledged to eradicating malnutrition. A speech by
the president or a cabinet minister, the sight of a respected tribe leader
eating some forbidden food and coming to no harm or the return to the village of
educated and enlightened local people will prove much more effective than the
preaching or goading of an outsider.

Changing food habits

In some parts of the world the staple foods are changing or
have changed. Maize, cassava and potatoes, now grown in large amounts in Africa,
originated outside the continent. Since none of these foods were eaten in Africa
a few hundred years ago, it is clear that the food habits of millions of people
have changed. Vast numbers of people in Africa have abandoned yams and millet
for maize and cassava, just as many in Europe abandoned oats, barley and rye for
wheat and potatoes. Food habits are still changing rapidly. The difficulty, of
course, lies in trying to guide and foster desirable changes and to slow down
undesirable ones.

It is often difficult to fathom what factors have been most
important in stimulating or influencing changes in food habits. The rapid
increase in bread consumption in many African, Latin American and Asian
countries where wheat is not the staple food is understandable. It is at least
in part a labour-saving phenomenon; bread is one of the first "convenience"
foods to have become available. Before leaving home to go to work one can eat
some slices of bread instead of the traditional breakfast of porridge, which
requires preparation time and is unpleasant cold. Bread can be carried in the
pocket and eaten during a break in the working day, or when
travelling.

In most of the world the traditional main staple food has
remained constant, irrespective of urbanization, modernization or even
westernization. Thus in much of Asia rice remains the preferred staple food in
rural and urban areas. Some people in Africa, such as the Buganda in Uganda and
the Wachagga in the United Republic of Tanzania, continue to have a preference
for plantains as their staple food. Maize based products such as tortillas
remain important in the diets of most Mexicans and many in Central
America.

Changes in food habits are not just accidental, of course; they
can be deliberately initiated. At community and family level, school-age
children can be important agents for change. They are still forming their tastes
and developing their preferences. If they are introduced to a new food they will
often readily accept it and like it. School meals may usefully introduce new
foods to children and thus influence food habits. This widening of food
experience in childhood is extremely important. Children may influence the
immediate family and later their own children to eat new, highly nutritious
foods.

Harmful new habits

Not all change is desirable, of course, and not all new food
habits are good. Chapter 7 describes in detail
the harmful effects of the rapid spread of bottle-feeding using infant formula
or animal milk in place of breastfeeding. This is an undesirable, relatively
new food trend. Less attention has been given to the question of other baby
foods that have been marketed and much promoted and advertised in developing
countries. Locally available complementary or weaning foods, home-produced and
traditionally fed, are often as or more nutritious than the manufactured baby
foods, and then are always much cheaper. They are usually introduced gradually
while breastfeeding continues well into the second year and beyond. Manufactured
baby foods should only be promoted to those who are unable or unwilling to continue
breastfeeding. They are safe and nutritionally adequate when prepared hygienically
and in the right dilution. They are convenient for those who can afford to purchase
them. However, such manufactured foods are expensive compared with local foods,
and for most families in developing countries, other than the very affluent,
they may be a waste of money. For families who already have too little money
to spend on food and other essentials, these foods are a very expensive way
of buying the nutrients that they are advertised to contain.

Another particularly misleading type of advertising relates to
the glucose products said to provide "instant energy". Energy is present in
large amounts in nearly all the cheapest foods. Similarly, drinks advertised as
"rich in vitamin C" are usually unnecessary, since few children suffer from
vitamin C deficiency. Vitamin C can be obtained just as well from fruits such as
guavas, mangoes and citrus, or from a range of vegetables.

The so-called protein-rich weaning foods are also much
advertised. These arc nutritionally good products, but they cost much more shall
protein-rich foods available in the market such as beaus, groundnuts or dried
fish, meat, eggs or milk. It usually costs much more to provide 100 g of protein
from these commercially advertised products than, for example, from beans bought
in the local market. The essential question is how a mother could best improve
her child's diet if she had a little extra to spend. The answer would seldom be
a manufactured baby food.

In some countries the staple food has remained unaltered, but
the form in which it is preferred may have changed over the years. As described
in Chapter 16, the rapid spread and popularity
of highly milled rice in Asia had disastrous consequences and led to a high
prevalence of beriberi, with much morbidity and many deaths. In many parts of
the world highly milled cereals have replaced traditionally lightly milled and
more nutritious wheat, rice and maize. In the United Kingdom and the Russian
Federation, white bread has replaced brown or whole-grain breads, and in East
Africa highly milled maize meal is often purchased and has replaced lightly
milled maize flour. Urbanization, modernization and sophistication have often
led to diets in which a greater percentage of energy intake comes from sugar
and fats, and to increased consumption of salt. All Of these are generally undesirable
changes from a nutritional standpoint.

Influencing change for the
better

What can health workers or nutritionists in a community do
about food habits, old and new? They can:

· protect, support and help preserve the many excellent
existing food habits that are nutritionally valuable;

· respect the knowledge and customs of the people in the
community in which they work;

· set good examples in their own households by adopting good
food habits;

· influence respected local leaders to state publicly that
they themselves have dropped undesirable food taboos, and arrange for them,
when occasion arises, to eat "forbidden" foods in public;

· persuade people not to abandon good food habits under the
influence of "sophisticates" back from the city who may try to discourage
rural dwellers from eating nutritious traditional foods such as locusts or
lake flies or to encourage the consumption and production of European-type
vegetables in place of better traditional ones;

· explain the disadvantages of highly refined cereal flours
if they have become popular in the area, and advocate the consumption of a
range of cereals in the local diet;

· take the steps described in Chapter
7 to protect, support and promote breast-feeding and to eliminate all
promotion of breastmilk substitutes;

· discourage poorer families from purchasing manufactured
baby foods, and encourage the use of locally available complementary
foods;

· issue informational material to help stop the spread of
bottle-feeding and the unnecessary purchase of expensive baby
foods;

· strive, through civil service or local authority
organizations, for the introduction of the payment of weekly wages instead of
monthly wages to employees, and influence labour and trade union leaders to do
the same;

· take steps to introduce good feeding practices in the local
schools and other institutions.

Chapter 38 describes the use of
social marketing and other well-tested nutrition education techniques that can
help achieve some of these objectives.